Rheumatoid Arthritis Proximal Interphalangeal Joint Arthrodesis

R. John Naranja, Jr. and Kevin D. Plancher History and Clinical Presentation

A 50-year-old right hand dominant man was originally diagnosed with rheumatoid arthritis 16 years ago. Medical management of his disease process has included chronic oral prednisone. His primary complaint includes pain and deformity of his hands and decreased function secondary to lack of mobility and strength.

Physical Examination

The patient has ~25 degrees of ulnar drift at the index through small finger metacarpophalangeal (MP) joints. An extension deficit at the MP measures ~45 degrees. The arc of motion of the digits at the MP is 20 degrees. The proximal interphalangeal (PIP) joint of the index and long fingers demonstrates a 30-degree flexion contracture with pain and crepitus with range of motion. Key pinch strength is 30 N and grip strength is 70 N at position II using the Jamar dynamometer.

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